Provider Demographics
NPI:1932163193
Name:MILLER, PETER W (PT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:W
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3628
Mailing Address - Country:US
Mailing Address - Phone:617-541-6418
Mailing Address - Fax:617-541-6312
Practice Address - Street 1:291 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3628
Practice Address - Country:US
Practice Address - Phone:617-541-6418
Practice Address - Fax:617-541-6312
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA908025OtherTUFTS HEALTH PLAN
MA0310034Medicaid
MAY67460OtherBLUE CROSS
MA0014447OtherNEIGHBORHOOD HEALTH PLAN
MAB501027OtherCIGNA
MAHV0001OtherHARVARD PILGRIM
MAHV0001OtherHARVARD PILGRIM